局麻下电磁针尖引导经会阴前列腺mpMRI-TRUS影像融合靶向穿刺的临床应用

Application of Magnetic Resonance Imaging and Transrectal Ultrasound Image Fusion Targeted Transperineal Biopsy Technique Using Electromagnetic Needle Tracking Under Local Anaesthesia

目的探讨局麻下电磁针尖引导经会阴前列腺多参数磁共振-经直肠彩超(mpMRI-TRUS)融合靶向穿刺活检临床应用的有效性和安全性。方法回顾性分析81例行局麻下电磁针尖引导经会阴前列腺mpMRI-TRUS影像融合靶向穿刺活检患者的临床病理资料。应用视觉模拟评分(VAS)和视觉数字评分(VNS)评估患者前列腺穿刺活检时(VAS-1和VNS-1)、术后1 h(VAS-2和VNS-2)和术后1 d(VAS-3和VNS-3)的疼痛程度和穿刺满意度,记录围手术期临床资料和术后穿刺活检的肿瘤阳性检出率。结果本组81例患者平均前列腺体积53.39±29.46 cm3。PIRADS评分2、3、4和5分患者的PSA值分别为9.14±2.31、9.95±4.10、14.77±6.36和32.17±24.39ng/ml。VAS-1、VAS-2和VAS-3分别为1.70±0.73、1.16±0.58和0.53±0.55分;VNS-1、VNS-2和VNS-3分别为2.74±0.44、3.69±0.46和3.84±0.37分。平均手术时间为17.47±3.44 min。术后病理结果提示靶向穿刺活检的肿瘤阳性率为64.20%。根据PIRADS评分进行亚组分析,PI-RADS评分2、3、4和5分患者穿刺活检的肿瘤阳性率分别为21.43%、44.44%、61.11%和96.77%。穿刺术后19.75%患者出现肉眼血尿,3.70%患者出现尿潴留,经对症治疗后缓解。所有患者均未出现会阴穿刺区域血肿、尿路感染、血精、迷走神经反应和感染性休克等并发症。结论对于前列腺癌可疑患者,局麻下电磁针尖引导经会阴前列腺mp MRI-TRUS影像融合靶向穿刺是一种可行且易耐受的手术操作方式,安全性好,具有较高的肿瘤阳性检出率,值得临床进一步推广应用。

Objective To explore the effect and safety of magnetic resonance imaging and transrectal ultrasound(mpMRI-TRUS)image fusion targeted transperineal biopsy technique using electromagnetic needle tracking under local anesthesia.Methods We retrospectively analyzed the clinical and pathological data of 81 patients with mpMRI-TRUS image fusion targeted transperineal prostate biopsy using electromagnetic needle tracking under local anesthesia.Visual analog scale(VAS)and visual numeric scale(VNS)were used to evaluate the pain level and satisfaction of patients during prostate biopsy(VAS-1 and VNS-1),one hour after puncture(VAS-2 and VNS-2),and one day after surgery(VAS-3 and VNS-3).The perioperative clinical data and tumor positive rate of postoperative biopsy were recorded.Results The average prostate volume of 81 patients was 53.39±29.46 cm3.The PSA values of patients with PI-RADS scores of 2,3,4,and 5 were 9.14±2.31,9.95±4.10,14.77±6.36,and 32.17±24.39 ng/ml,respectively.The scores of VAS-1,VAS-2,and VAS-3 were 1.70±0.73,1.16±0.58,and 0.53±0.55,respectively;the scores of VNS-1,VNS-2,and VNS-3 were 2.74±0.44,3.69±0.46,and 3.84±0.37,respectively.The average surgical time was 17.47±3.44 minutes.Postoperative pathological results showed that the tumor positive rate of targeted prostate biopsy was 64.20%.According to the PI-RADS score for subgroup analysis,the tumor positive rates of patients with PI-RADS scores of 2,3,4,and 5 were 21.43%,44.44%,61.11%,and 96.77%,respectively.After transperineal prostate biopsy,gross hematuria occurred in 19.75%patients,and urinary retention occurred in 3.70%.The latter were relieved after symptomatic treatment.All patients did not experience complications,such as perineal puncture area hematoma,urinary tract infection,hematospermia,hematoma in perineal puncture area,urinary tract infection,hematospermia,vagus nerve reaction,or septic shock.Conclusion For suspected prostate cancer patients,mpMRI-TRUS image fusion targeted transperineal biopsy technique using electromagnetic needle tracking under local anesthesia is a feasible and easily tolerated surgical procedure.It has good safety and high tumor positive-detection rate,indicating that this technique is worthy of further clinical promotion and application.